The World Bank Brazil-Salvador Social Multi-Sector Service Delivery Project (P162033)

new strategy is expected to place comparatively greater emphasis on measures to improve service quality and ensure long-term fiscal sustainability of these services. Key thrusts of the strategy to improve education service delivery are the establishment of effective monitoring and evaluation (M&E) systems and specific policy actions to ensure fiscal sustainability of the sector wage bill. Robust M&E systems are a necessary, though insufficient, basis to oversee performance of the service deliverers (e.g., through a formal accreditation program) and devise appropriate remedial interventions, if necessary, to address observed weaknesses. Concerns about fiscal sustainability of its expenditures is paramount and some of the actions taken in the last several years have necessitated a more measured approach to managing the fiscal dimensions of service delivery expansion. On the one hand the aggressive investments in the last several years have increased the total recurrent spending in the education sector considerably, with non-salary recurrent cost requirements increasing by 9 percent in real terms in both 2015 and 5 2016. Meanwhile, the sector's payroll increased by 38.5 percent between 2012 and 2015. The wage bill pressure has been exacerbated by the need to hire about 1,700 temporary teachers to comply with the new national legislation, which required reserving 30 percen t of teachers' time for teacher professional development and lesson planning. Additionally, the Municipal Assembly approved a new teachers' career plan in 2014, which increased teacher salaries and created a bonus for all teachers regardless of performance. This increase will have impact on the long-term pension liability for the city. Finally, SMED significantly increased the number of outsourced employees who support schools and administrative regions of the school system, such as drivers and administrative assistants. In health, Salvador needs to continue expanding its primary care coverage. More importantly, poor coordination across the three healthcare levels (primary, secondary and tertiary) is a main obstacle to attaining effective and sustainable healthcare in the local system, leading to difficulties in access to care, poor technical quality, discontinuity of care and inefficiencies in the use of resources. These weaknesses are particularly relevant in the care of patients with chronic conditions that require coordination across different settings and providers. Healthcare for these conditions is becoming an increasingly significant challenge to health services, especially with the worsening of fiscal and economic crisis. While completing the ongoing projects for facility improvement/expansion, the Municipal Secretariat of Health (SMS) has developed an information management system ( Sistema de Regulação Vida, or Sistema VIDA ) to regulate and manage patient flows between the different levels of care (i.e., between different types of facilities), including with facilities outside the municipal network (e.g., state-run facilities) and modernize some of its management processes and systems. SMS plans to upgrade and expand the use of Sistema VIDA over the next few years. In social assistance, the priority measures for strengthening SEMPS' organizational capacities is somewhat more basic. SEMPS needs to revisit and adjust its organizational structure in line with the enhanced responsibilities and increased workload, recruit qualified professionals for both policy management and service delivery functions, institute an effective program of ongoing staff training, and modernize its management systems and practices. While encouraging each sectoral secretariat to pursue its own set of measures to increase access, improve quality and ensure sustainability, the Municipality has also developed, and is intent on further refining, a set of cross-cutting management initiativ es. Some of these measures are intended to sharpen the municipal administration's capacity to prioritize its actions and monitor their implementation. Others are explicitly intended to improve the efficiency of municipal expenditures and/or control future growth of expenditures, especially personnel expenditures.